Silent Nite: Treatment for Snoring?

silent_nite_07.jpgI am reading more and more about Sleep Dentistry and Obstructive Sleep Apnea. Some of my patients who snore have started to ask me about wearing an appliance or having surgery to cut down on their snoring.

I have seen many advertisements for training courses and products in this area and I see that this is becoming a growth area in dentistry. But I am worried about masking significant signs and symptoms by making a snoring appliance. I believe that Silent Nite [Glidewell Labs] is the most widely used appliance for snoring. What are other dentists doing about this area? Do you send the patient to a physician to be evaluated or do you do you own evaluation? How difficult is it to adjust the Silent Nite appliance? Has it helped your patients?

Editor´s Note:
According to Glidewell Labs:

Relaxed and collapsed airway produces soft tissue vibrations during breathing that result in snoring. The Silent Nite device positions your lower jaw forward, keeping your airway open, allowing easier breathing and preventing snoring. The special connectors allow your lower jaw to move freely providing maximum comfort during sleep.

Snoring research has also shown that custom fabricated dental devices worn at night that
move the lower jaw into a forward position, increase the three dimensional space in the airway
tube which reduces air velocity and soft tissue vibration. By increasing the volumetric
capacity of the airway and preventing soft tissue vibrations, snoring is eliminated. In clinical
research studies, these dentist prescribed oral devices have exhibited initial snoring prevention
success rates of between 70 to 100%.

The SILENT NITE device positions the lower jaw into a forward position by means of special
connectors that are attached to transparent flexible upper & lower forms. The forms
are custom laminated with heat and pressure to the dentist’s model of the mouth.The fit is
excellent and comfortable. “

5 thoughts on “Silent Nite: Treatment for Snoring?

  1. I am a dentist and a personal user of this device. It works and as stated above is comfortable to wear. It is non invasive and so is a good first step in treatment of obstructive sleep apnea.
    If available a sleep study as a baseline is lways helpful. If however this study is not readily available you can still go ahead and make the appliance. The study can be done later as the appliance is making no permanent changes to the airway.


  2. There are several courses that are now being offered to train dentists in oral appliances for snoring and sleep apnea. A PSG (sleep study) should ALWAYS be performed. Home studies are now being reimbursed and although dentists are not qualified to read studies, a dentist should have no problem finding a sleep center, pulmonologist, ENT, or a certified sleep doctor that will gladly read the study for you.

    There are over 90 oral appliances available besides the silent night. Some have locking mechanisms in the anterior, such as the TAP, while others like the Somno Med have acrylic wings that interlock. No one style is correct and a successful sleep doctor will have 2 or 3 designs that best address the needs of the patient. When and which style is right will be presented in any of the course you attend.

    Sleep dentist also have the ability to diagnose airway obstruction with a rhinometer/ pharyngometer. Acooustic rhinometry uses acoustic signals to acquire quantitative measurements of the nasal cavity. Rhinometry allows for airway patency, site of airway obstruction, and degree of airway obstruction. Once a dentist sees nasal obstruction, the patient can be sent to an Otolaryngologist so that the nasal obstruction can be corrected prior to making an oral appliance. If the sinuses were not diagnosed and an appliance were to have been made for the patient, the outcome would be less than optimal.

    Acoustic pharyngometry is a diagnostic system used for the objective assessment of the upper respiratory airway. The pharyngometer uses acoustic signal processing technology to provide graphical representations of airway patency as a function of distance from the airway opening. It is a dynamic test that determines dimension of the oral airway past the glottis while the patient is breathing. Computer processing of the incident and reflected sound signals provides an area-distance curve representing the lumen together with minimal cross-sectional area and volume. Because the results can be reproducible and can be obtained rapidly, the dentist can set the advancement and vertical dimensions in small increments until an ideal opening is set. Utilization of pharyngometry allows the objective customization of each oral appliance eliminating under or over advancement.

    By utilizing pharyngometry the doctor is maximizing the opening of the airway behind the tongue base, and at the same time not over advancing the mandible, which would create joint pain. The result is a more optimal oral appliance. You will find some dentists believe rhinometry /pharingometry as a necessary diagnostic tool and others think it is useless. Courses from Sleep GS can help you determine if this is something you want to get involved in.

    Along with the sinuses and the tongue being key components in snoring and sleep apnea, the soft palate is also a major contributor to the disease. Restore Medical (which has just been purchased by Medtronic and I am an employee of) manufacturers polyester implants that are implanted in the muscle of the soft palate. The procedure is done in the office under local anesthesia and is performed in less than a half hour. Most patients experience a mild sore throat for the next 24 to 48 hours and can return to normal activities the same day as the procedure. It takes 90 days for a fibrotic response to occur in the muscle tissue, which stiffens the soft palate. Pillar in conjunction with an oral appliance, addresses both the soft palate and the base of tongue in a minimally invasive, non-invasive manner.

    In order to be an effective sleep dentist, you should attend any of the courses sponsored by the AADSM, and get involved with your local Pulmonologist, Sleep centers, Oral Surgeons and Otolaryngologists study clubs. Treating one portion of the airway, most likely will not get it done, and you will need a comprehensive, multi leveled approach. The airway is complicated and there is no true diagnostic tool showing where the obstruction is occurring. Once you respect and understand this, you will be able to treat the patient and get a more optimal result. Snoring and sleep apnea is in its infancy and new developments are occurring daily.

    Thank you for asking the question and please accept my apologies for the little plug on the Pillar Procedure!

  3. If patients’ dentition and temporomandibular joints are healthy, beginning treatment with dentist-prescribed oral appliances may become a preferred approach. Oral appliances are easy to try, effective for many at reducing symptoms, and oral appliances probably are the best initial therapy for two reasons: (1) they are less costly and less invasive than surgery; and (2), they are less costly than CPAP systems and have been demonstrated to have better compliance.

    So, who is a candidate for an oral appliance? A recent study of patients with sleep disorders found that an ideal candidate is a patient “with mild-to-moderate sleep apnea. . . . who is not obese, who snores or has mild-to-moderate OSA, who has an adequate protrusive range of motion of the mandible and who has adequate dentition [and] patients who cannot tolerate CPAP or in those with whom surgical intervention failed.” (Neda Mohsenin, et al., The role of oral appliances in treating obstructive apnea, JADA, Vol. 134, April 2003).

    For severe OSA cases where CPAP therapy is necessary, an oral appliance may be used to manage the airway, in conjunction with CPAP, for enhanced OSA treatment. The combination therapy for these patients can result in greater patient comfort and compliance because CPAP pressures can be decreased, with less advancement of the jaw, compared to OSA treatment using CPAP or jaw positioning independently. “The ideal algorithm would be to treat the patient first with oral appliances and then add CPAP as necessary when the patient cannot be managed by oral appliances alone,” according to Dr. W. Keith Thornton, a dentist at L.D. Pankey Institute in Dallas; he adds that this “is similar to the approach of cardiopulmonary resuscitation–managing the jaw position first and then ventilating as necessary” (see, “Combined CPAP – Oral Appliance Therapy,” Sleep Review Magazine, Jan./Feb. 2002, Vol.3, No.1).

    A recent study (see, U.K. Tan, et al., Mandibular advancement splints and continuous positive airway pressure in patients with obstructive sleep apnoea: a randomized cross-over trial, European Journal of Orthodontics 24 (2002) 239-249), confirms the effectiveness of the Silent Nite® MRD (known as “Silencer” in Europe). A summary of the study is as follows:

    “This prospective, randomized, cross-over trial was designed to compare the efficacy of a mandibular advancement splint (MAS) with that of nasal continuous positive airway pressure (nCPAP) in patients with obstructive sleep apnoea (OSA). Twenty-four patients (20 males and four females) with mild to moderate OSA (AHI between 10 and 49 events per hour) were enrolled in the study. Each patient used both MAS and nCPAP, with the initial therapy being allocated at random. Treatment periods lasted for two months with a two-week wash-out interval between. Polysomnography was performed prior to the study and after each clinical intervention. Patient and partner questionnaires were used to assess changes in general health and daytime somnolence.

    “The AHI decreased from 22.2 to 3.1 using nCPAP, and to 8.0 using the MAS (P

  4. I only wear my Silent Nite when my wife elbows me in the side. After I put it in there are no more elbows, so I am 100% sure it works for loud snoring.

  5. I haven’t actually seen that particular device before. Most of the more inexpensive dental appliances can be fitted by the end user and even ordered off of sites like amazon. That one pictured, does look a lot less bulky though so it may not restrict the airway as much. I had a bad experience with a sleep doctors trying to steer me into CPAP after one friggin’ expensive sleep study. I blogged about it on my site..
    I tried out a few different products and ended up using a mouthpiece that worked wonders. There’s a few difficulties with it which I go into some detail about on the site, but for the most part I get at least 9 out of 10 nights success with it.

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